CHOLERA SURVEILLANCE IN THE CONTEXT OF INTEGRATED DISEASE

SURVEILLANCE AND RESPONSE (IDSR) IN SOUTH SUDAN

GTFCC Meeting for the Working Groups on Surveillance (Epidemiology and Laboratory) (15th to 17th

March 2019)

Definitions

Surveillance

systematic and organized collection, analysis of data to inform public health action

Integrated disease surveillance and response (IDSR)

A strategy of the WHO in the Africa region that fosters integration and optimal use of resources to enhance surveillance, response, and laboratory capacities at the district level

Early Warning Alert and Response Network (EWARN)

This is an adjunct surveillance system established during humanitarian emergencies to address the disease surveillance and response needs that cannot be addressed by the national disease surveillance system (IDSR)

IDSR in South Sudan

4/25/2019 3

2006

Adopted as the national strategy for disease surveillance in South Sudan in 2006

Dec. 2013

By Dec 2013 – rolled out to 10 states and 80 counties

2013

EWARN setup in 2013 (following the onset of the current crisis) to support disease surveillance and response in conflict-affected states (where IDSR was not functional)

Current Flow of IDSR data

Local level

Hospital/PHCC/PHCU

Boma: BHT, HHP

Intermediate levelState – SSOs

CHD – CSOs

National level – MoH (EP&R; PHEOC, M&E)

Paper based IDSR forms submitted for Aggregation at the county level

- Paper based IDSR reports entered-Aggregated and entered into EWARS

-And submitted

- EWARS forms transmitted -Electronically to the state level

-And national level

- Event alert

- verification

- Assessment

- Intl response

Points of entry

Arrows show the flow of surveillance data through the health system

ENHANCING IDSR IN SOUTH SUDAN

Deployment of web-based mobile device enabled EWARS

The EWARS Project- The Global EWARS project is an

initiative to strengthen early warning,

alert and response in emergencies.

- It supports Ministries of Health and

health partners through the provision of

technical support, training and field-

based tools.

- It can be rapidly configured and

deployed within 48 hours of an

emergency being declared.

- It is designed with frontline users in

mind, and built to work in difficult and

remote operating environments

Objectives of EWARS

The specific objectives are to:

1. Strengthen the ongoing collection, analysis and interpretation of

public health data;

2. Trigger alerts to potential disease outbreaks at the earliest possible

interval and develop strong links with laboratory surveillance to confirm

the cause of the outbreak;

3. Monitor the course of confirmed outbreaks and direct control

measures to stop the outbreak from spreading.

Principles

EWARS supports three main functions of IDSR 1. Surveillance - data collection, transmission, trend analysis2. Alert - flagging events above threshold3. Supporting outbreak response - line listing; contact management

EWARS Field Support

Flow of IDSR data after mobile reporting is introduced at health facility level

Data will be collected in the health facility OPD register

Data will be summarized on to tally sheets

Data will be entered into the IDSR health facility paper weekly reporting form

Data will be entered into the health facility EWARS phone and submitted

County Health Department

State Ministry of Health

National Ministry of Health Once data

is submitted from the EWARS

phone; it will be

received at the CHD; sMoH; & nMoH in real time

Cholera Surveillance in the IDSR Context

• Cholera is a priority disease for surveillance in

South Sudan

• South Sudan IDSR Technical Guidelines

describe the

• Cholera case definition

• Surveillance and response guidelines

Standard Case definition for cholera

In an area where the disease is not known to be

present: a patient aged 5 years or more develops

severe dehydration or dies from acute watery

diarrhoea

In an area where there is a cholera epidemic: a patient

aged 2 years or more develops acute watery

diarrhoea, with or without vomiting

Community case definition for cholera Anyone with lots of watery stools

Republic of South Sudan

Ministry of Health

JUNE 2013

Technical and Financial Support by ECHO, USAID and W HO

Surveillance Procedure for Responding to a Suspect Cholera Case

Case meets case definition at the health

facility

State/County notified about suspect case

National MoH notified thru hotline

Data received at county, state, national level in

real-time

Suspect cholera case in the community seeks care at health

facility

Suspect cholera case in the community detected & reported to the health

facility by community worker or leader

Initial case verification by HF

Case registered into alert log & line list

State/County RRT dispatched

National RRT may be dispatched

Event-based & line list data entered into EWARS at HF level

Activation of the cholera taskforce

Notification to WHO thru the IHR NFP

Generation of real-time situation reports

If cholera is confirmed

If requested by state

If suspect cases exist

IDSR Task Force meeting19-22 September 2017 ׀Entebbe, Uganda

EWARS Supports Real-time - Event & Indicator based Surveillance

IDSR Task Force meeting19-22 September 2017 ׀Entebbe, Uganda

EWARS Supports Cholera Line listing & Real-time Situation Updates

EWARS dashboard E WARS L INK

4/25/2019 16

Thank you